Manderson: Health co-pays will take time

Cayman’s chief civil servant told lawmakers Monday that it would take some time to implement a system of co-payment for government workers’ healthcare plans, an idea that has been floated by the Progressive-led government administration since last year.

Deputy Governor Franz Manderson told the Legislative Assembly that while he understood the need to reduce the territory’s looming $1.18 billion future healthcare liability over the next 20 years, significant changes to the system could not be rushed.

“Proper planning and preparation prevent poor performance,” Mr. Manderson said. “You cannot change something like healthcare [policy] provisions overnight. We have to understand what the implications are for civil servants and the [Health Services Authority].”

Mr. Manderson also clarified that while the elected government had the right to raise the issue of healthcare co-pays, it is the Cayman Islands governor who has authority for the terms and conditions of the civil service employment contracts. In practice, the governor delegates her authority to the deputy governor [formerly the chief secretary] as head of the civil service.

“[It’s] grossly unfair [to] accuse the government of pushing this issue down the road,” Mr. Manderson said. “This is something that will take time.”

According to details provided to the Cayman Compass as part of a 2014 Freedom of Information request, retired pensioner rates under the Cayman Islands National Insurance Company plans are $870 per month for non-married individuals, $1,306 per month for non-married people with children, $1,741 per month for married couples, and $2,176 per month for the CINICO family plan. Similar rates for working civil servants are $416 per month for single adults, $832 per month for married couples and the same for single adults with children, and $1,242 per month for families.

Neither retired civil servants nor active government workers are required to make co-payments; their monthly premiums are funded entirely by government.

In addition, both civil service plans under CINICO have a $5 million maximum “lifetime limit” for healthcare coverage. There are no limits on prescription drug purchases, or inpatient or outpatient care. Overseas accommodations and airfare, if the covered government worker or retiree must fly off island to obtain treatment, are covered 100 percent.

In introducing the upcoming government budget, Finance Minister Marco Archer last week said Mr. Manderson would begin reviewing whether government workers should fund a portion of their own healthcare costs through a co-payment system. Mr. Archer said government hopes a “modernized” healthcare payment system for civil servants can be put in place by 2018.

Mr. Archer said late last year that keeping current benefits for civil service workers, retirees, seamen and veterans will result in healthcare costs that eventually will overwhelm the Cayman Islands government’s annual budget. “[The current system] is simply unaffordable and something must be done in the long-term interests of the Cayman Islands,” Mr. Archer said.

Co-payment for civil servants’ healthcare is just one option being explored by the government. Among the changes proposed are increasing the government’s mandatory retirement age from 60 to 65; reducing the current “lifetime” healthcare benefits cap for civil servants from the current $5 million; and considering a “graduated scale” of health benefits for retirees based on their years of service in government.

The retirement age increase is expected to be approved later this year, Mr. Archer said. Reducing the “lifetime” cap could also be done simply through a legislative change.

Creating a graduated system of healthcare benefits based on time spent working in the civil service is likely to be more complicated, but Mr. Archer said he believes such a scheme could be developed without impacting current retirees.